Provider Demographics
NPI:1316197965
Name:PARTNERS IN COUNSELING LLC
Entity Type:Organization
Organization Name:PARTNERS IN COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:MA,LADC
Authorized Official - Phone:860-423-4279
Mailing Address - Street 1:387 TUCKIE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:NORTH WINDHAM
Mailing Address - State:CT
Mailing Address - Zip Code:06256-1355
Mailing Address - Country:US
Mailing Address - Phone:860-423-4279
Mailing Address - Fax:860-423-4284
Practice Address - Street 1:387 TUCKIE RD
Practice Address - Street 2:SUITE D
Practice Address - City:NORTH WINDHAM
Practice Address - State:CT
Practice Address - Zip Code:06256-1355
Practice Address - Country:US
Practice Address - Phone:860-423-4279
Practice Address - Fax:860-423-4284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2014-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000055101YA0400X
CT0030251041C0700X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004165397Medicaid